Mrs Amanda Jupp, Cabinet Member for Adults and

Health

Ref No: AH01 (20/21)

April 2020 Key Decision:

Yes

Care Homes & Care Services: Indicative Rates & Fees for Adult Social Care

Part I

Report by Executive Director of Adults and Health Electoral Division(s): All

Summary

Rates and fees paid to independent providers of adult social care provision in the community and in residential and nursing homes are subject to annual

review.

The County Council has included funding in its budget for 2020/21, which

covers both the effect of inflation and a contribution towards the increase in the National Living Wage that will apply on 1 April 2020. The proposals

outlined below utilise this funding to support the Council’s Vision and Strategy for Adult Social Care, to be delivered through commissioning intentions as

detailed in market position statements. This approach supports the drive to shape communities, builds on an asset-based approach and incentivises the

care market, to grow, shape and deliver services to meet the needs of adults eligible for care funded by the local authority.

This report sets out proposals for increases in a range of fees and rates and the factors considered in setting those fees and rates.

It is our priority to ensure that the market can cope with vulnerable people at

this unprecedented time dealing with COVID-19, therefore the Council is making provision to address financial pressures resulting from this

independently of this decision.

West Sussex Plan: Policy Impact and Context

Independence in Later Life and a Prosperous Place are the two priorities supported by this paper; recognising the cost of delivering services to support individuals eligible for services, and paying rates and fees that contribute to creating sustainable businesses and attracting new entrants into the West Sussex care market

Financial Impact

The 2020/21 Adults and Health budget includes funding of £5.5m for the

effect of the proposals in this report, of which £0.4m will be met by the West

Sussex Clinical Commissioning Group through the pooled budgets for learning disabilities and working age mental health.

Recommendation

The Cabinet Member for Adults and Health is asked to approve uplifts that

will apply to care services funded by West Sussex County Council Adult Operations from April 2020, as detailed in Section 2 of this report and

Appendix 1.

Proposal

1. Background and Context

1.1 West Sussex County Council, through its department of Adults and Health,

commissions independent care providers to provide care and support services to meet the assessed needs of eligible adults at a fee agreed with those

providers.

1.2 In its October 2019 State of Health Care and Adult Social Care in England

2018-19 report, the Care Quality Commission (CQC) stated that ‘The stability of the adult social care market remains a particular concern. There is still no

consensus on how adult social care should be funded in the future. Twice in 2018, we had to exercise our legal duty to notify local authorities that there was a credible risk of service disruption because of potential failure of a

provider’s business. An estimated 1.4 million older people (nearly one in seven) do not have access to all the care and support they need.’

1.3 The report also acknowledges that the number of residential and nursing home

beds has been falling steadily in all regions over the last five years, which

reflects a national and local ambition to support people to remain at home for as long as possible. This is also true in West Sussex, according to CQC data

there are two fewer nursing homes and three less care homes registered in West Sussex in December 2019 compared with December 2018, closures have continued into 2020 which are not yet reported. Conversely there has been

an increase in West Sussex of registered domiciliary care offices over the same period, increasing from 153 to 164. Although the number of organisations

continues to grow, workforce issues remain a pressure for the sector. Skills for Care reports staff turnover in all roles has risen over the last six years, with

care workers having the highest rate, at 40%. The sector also has a dependency on workforce from the European Union; nationally around 1 in 11 posts are filled by such people, and many commentators are concerned about

the implications of the Government’s points-based system for migrants on the future supply of workers.

1.4 Adults’ Services vision and strategy is based on the principle of supporting

adults who have social care needs to be as independent as possible throughout their lives, with a focus on people’s strengths and community

networks, supporting people closer to where they live. In addition, it is understood that most people want to be able to continue living in their own home for as long as possible.

1.5 The proposals for increases are focussed on where the Council wants to

increase capacity in line with this vision and strategy i.e. services that support

people to remain in their own homes such as domiciliary care and supported living, and acknowledging the importance of retaining care homes with nursing

and care homes to support people living with dementia, to give families respite and to support people on a long term basis when they can no longer safely remain at home.

1.6 Independent providers also offer care services to people who will be paying for care themselves. In West Sussex, the proportion of people aged over 65 funding their own care is much higher than those funded by the Council. This

creates competition for provision which has a significant impact on the level of fees that the County Council will need to pay to secure care services. That

competition is intensifying and is adding to price pressure, this is partly evidenced by the increase in the number and cost of agreed rates (that is those rates which are agreed on an individual case basis as opposed to being set by

the Council) in the last 12 months for services commissioned for older people.

1.7 Under the Care Act 2014 a local authority has a duty to ensure sustainability of the care market and to ensure that there is sufficiency, diversity and quality in supply. Providers are autonomous businesses responsible for employing,

training and setting pay and terms and conditions for their own workforces. The County Council has to set fees that cover the legitimate costs of delivering

the service and make a fair return to support the business to be sustainable.

1.8 However, despite these factors having an upward influence on fees for care, local authorities must comply with related public law duties; which include

ensuring that the funding available to the local authority is used to meet the needs of the entire local population. The County Council, therefore, must agree

fees with providers which are affordable to the public purse, fit within a regional context and take into reasonable consideration its own finances and

budgetary position, alongside those of the market. 1.9 Annually, commissioners undertake a review of the rates, fees and charges the

Council pays to independent providers of adult social care based in West Sussex. In addition to statutory and market considerations, commissioners

have also considered other factors including: Contract clauses on price revision and annual inflation. Pressures on providers including (but not limited to) statutory obligations,

paying the national living wage, sleep-in costs (predominantly Learning Disabilities supported housing and residential services), auto enrolment of

pensions and increased regulatory costs (CQC). Intelligence from the market gained through provider forums, meetings

with individual providers, representations from providers and market

reports that inform commissioning Private rates paid in West Sussex and what is a fair ‘public’ rate/fee to pay,

taking account of guides (for example) on minimum rates. Response from West Sussex Partners in Care (the local care association)

and representations from other providers on pressures and expectations of

the market, difficulties in recruiting and, increasingly the difficulty in retaining staff against a backdrop of increased regulation and complexity

of need. Opportunities for innovation in service design and delivery that will support

more efficient models of care.

1.10 This year the increases that the Council proposes support what is set out in the published Market Position Statements for Lifelong Services and Older

People. In both there is a critical focus on building capacity to support everyone to be as independent as is possible for them and to support people to remain

safely in their own homes, also for as long as is possible.

1.11 To support building capacity the money available will be weighted towards those services that we need more of in West Sussex, consequently there will be lower increases or no increase for other services and fees. This is the

inescapable consequence of the County Council needing to prioritise the limited funding that it has available. The alternative would be a flat rate increase

across all care types, but this would result in an uplift that does not reflect the realities of the care market in West Sussex. That would be the case either whether viewed in context of the cost pressures facing providers, which are

not uniform, or the County Council’s commissioning intentions. For some providers it is acknowledged that the recommendations will be disappointing,

so another aspect of the recommendations is the creation of a resilience fund. In exceptional situations this will give providers, who consider that a higher uplift is necessary to maintain the viability of their business, the opportunity

to evidence why they should be treated differently. Equally it is hoped that the fund will signal to the market that the County Council is seeking innovative

ideas from providers, whether in respect of service delivery or arrangements based on the principle of payment by outcomes. For the first time, resources are being earmarked to actively encourage this because the future

sustainability of the adult social care budget means that the County Council will not be in a position to continue commissioning services in the same way

as it does today.

1.12 This report excludes block contracts as their costs are governed by the indexation provisions specified in those agreements

2. Proposal Details

2.1 The table shown below sets out the recommended fees; the context and

details underpinning the proposals are set out in the body of the report.

Service Current Fee £ New Fee £ Uplift

Care Homes and Care Homes with Nursing

Standard

Per week

Enhanced

Per week

Standard

Per week

Enhanced

Per week

Standard Enhanced

Band C -Specialist dementia

591.75

686.65

615.42

700.38

4%

2%

Band P -Frail with

intensive/complex

physical care needs

528.27 655.39 528.27 655.39 0 0

Band D - Baseline Social Care Rate (Accommodation

and Personal Care element of

Nursing Fee)

563.63

631.95

586.18

644.59

4%

2%

For respite stays up to 2 weeks

n/a £21 NEW 2020

Out of County Care Homes and Care Homes with Nursing

Out of county care homes on set

rates

Host Authority Rates

Host Authority Rates

Match set rates for new and existing

placements

Out of county care homes with

nursing on set rates

Host Authority Rates

Host Authority Rates

Match set rates for new and existing

placements

Out of county care

homes individually negotiated (all

customer groups)

Variable Variable Variable

Out of county care homes with

nursing individually negotiated

(all customer

groups)

Variable Variable Variable

Individually Agreed Rates

Individually

Negotiated

Variable Variable No change

Domiciliary Care/Care and Support at Home

Domiciliary Care Variable Variable Rates under

£20.69, increase by £1.40 per hour Rates above

£20.69, increase by £1.00 per hour.

Extra Care Housing

Extra care housing Variable Variable Up to 3% based on need

Supported Living and Community Support

Supported Living (including

community-based support) for

people with a Lifelong Disability

Maximum Ceiling Hourly rate

4%

Supported Living

(including community-based support) for adults

with assessed mental health

needs

Maximum Ceiling

hourly Rate

4%

Shared Lives

Shared Lives Variable Variable 2.5 %

Day Opportunities

Day services for people with a lifelong disability

Variable Variable 0%

Prevention Services

Prevention services for people

with a lifelong disability

Variable Variable 2.5%

2.2 Care Homes and Care Homes with nursing

2.2.1 The Council sets the rate at which it funds care for older people, most funded placements are made at these rates.

2.2.2 In reviewing the rates it pays, the Council has taken account of the services it

wants to continue to commission and those where alternative provision is needed to deliver the vision of independence through a strengths-based approach to care and support. This has also led to the recommendation that

an additional payment for respite stays of less than two weeks is introduced to encourage providers to accept short term placements, when commissioned

at indicative rates (shown at Appendix 1). The aim is to assist people to remain in their own homes for longer by supporting family carers to have a break and also when remaining at home is no longer possible this facilitates providers to

make provision for short stays prior to moving into a care home which assists familiarisation with the home and the individual. Since this is an incentive

payment to providers, rather than a cost relating to meeting care needs, it

should be noted that it will not be taken into account as part of the financial assessment process, which determines the contribution that each individual

customer pays towards the cost of their care package.

2.2.3 National living wage will increase on 1st April 2020, however the final phase of the employer minimum pension contributions has been reached meaning

that there are no further increases during 2020/21.

2.2.4 Neighbouring authorities’ rates have also been considered in the context of their demographic, geography and market dynamics.

2.2.5 In line with the Council’s commissioning strategy we recommend no increase to residential placements, however recognising the ongoing demand for

dementia placements and nursing placements the recommendation for the requisite standard rates is 4% and enhanced rates 2% (see Appendix 1).

2.3 Individually negotiated Rates

2.3.1 Some placements made in care homes and care homes with nursing are

individually negotiated. Placements for people with learning disabilities, physical and or sensory disabilities, acquired brain injury or functional mental

health needs tend to be individually negotiated but an increasing number of older people’s placements are also subject to negotiation.

2.3.2 There is no automatic increase to these rates, where a set rate is paid these

are already above the proposed new fee rate. Individually agreed fees vary significantly according to provider and individual user’s needs and by their very nature closely take prevailing market factors into account.

2.4 Out of County Care Homes and Care Homes with nursing

2.4.1 Where the Council funds placements outside of West Sussex, either at host

authority rates or individually agreed rates, it is recognised that the host local authority best understands its local care market. Therefore, the

recommendation is that the Council’s default position is to follow the approach taken by the host local authority.

2.5 Domiciliary Care/Care and Support at Home

2.5.1 The Council does not have a set rate at which it funds care and support at

home, this has been determined through a procurement process, therefore the rates paid vary across providers.

2.5.2 Through market engagement during 2019 providers in West Sussex clearly

articulated that recruitment and retention of staff was their biggest challenge against a backdrop of increasing costs.

If providers are unable to attract enough care workers to meet demand, it will become increasingly difficult to deliver our vision for adults living in West

Sussex. The Council has listened to the feedback and considered the impact on its strategic aims, as a result proposes to pay a higher rate of increase.

2.5.3 A higher award acknowledges the cost of delivering home care today1, but also supports to manage costs as the Council moves towards new

commissioning arrangements, which are due to come into effect in January 2021. Further, this sends a strong signal to the market that the Council wants to grow capacity to support people to remain in their communities and

in their own homes.

2.5.4 The overall available budget for these services will be increased by 6.2%. Due to the range of rates paid to providers, the Council proposes to

apportion this across providers by increasing rates below £20.69 by £1.40 per hour, and increasing rates above £20.69 by £1.00 per hour, in

preference to offering a blanket percentage increase. This approach enables an increase to all providers, whilst recognising that some services are charging below the UKHCA suggested minimum cost of care and may require

additional funding to sustain their services.

2.5.5 This increase will only be applied to those rates agreed under contract terms or through the annual uplift process

2.6 Extra Care

2.6.1 The Council currently has a Dynamic Purchasing System (DPS) which comes

to the end of its initial term in September 2020, subject to a future decision these arrangements will run beyond this term. The extra care contracts

across West Sussex provide care and support to people in their own home subject to a tenancy or lease agreement. This enables people to grow old in place and delay the need for residential or nursing care placements whilst

ensuring quality of life and maintenance of independence for as long as possible.

2.6.2 The proposal for a 3% uplift to budget, to enable this to be applied upon

request with increases up to 3%. This increase reflects the importance of investing in extra care as a key part of enabling the Council’s strategy and

vision. The importance of recruiting and retaining staff to deliver care in extra care settings is reflected in this proposal. The Council will apportion the uplift to this area according to the need presented by individual providers

in line with the contract arrangements, these rates will be uplifted from October 2020.

2.7 Supported Living

2.7.1 Supported Living is the term given to personal support services and includes

both the provision of accommodation based supported living schemes, where individuals hold a tenancy agreement and support is typically a mixture of

shared and individual support; and outreach services where care and support is delivered to an individual, but there is no shared support (i.e. people living with parents or alone).

These services are commissioned under framework contracts with maximum

ceiling hourly rates.

1 UKHCA’s minimum price for home care from April 2020 is £20.69 per hour

2.7.2 The Lifelong Disability and Autism Market Position Statement 2019 sets out the Council’s commissioning intentions, for this customer group. There is a

focus on the benefits of supported living services, in particular how it enables people to live as independently as possible within the community.

The Council intends to increase capacity and availability of these settings

through the development of a new Supported Living Model, due to mobilise in 2021. This will provide an alternative to residential placements, consequently, demand for residential services will reduce.

2.7.3 Commissioners are aware of the challenges to the market, particularly in

relation to recruiting and retaining staff to work in these services. There is a key dependency on a stable and increasing workforce to meet the Council’s

commissioning objectives around supported living, therefore an uplift of 4% is recommended.

2.7.4 The rate set for sleep-in (night-time cover) will not be subject to an uplift but

may be reviewed depending on the outcome of any future judgement on this issue.

2.8 Shared Lives

2.8.1 Shared Lives services support adults to live in the community within a family home setting; the carers provide accommodation, care and support in their

own home.

These services are commissioned from independent providers and are also directly provided by the Council. Shared Lives can be highly successful

arrangements and are seen as a critical element in offering a setting that focuses on developing independence to support moves to more independent

living.

2.8.2 In order to facilitate the expansion of Shared Lives to further client groups and increase capacity by attracting new carers (whilst recognising the self-employed status of carers) an uplift of 2.5% recommended.

2.9 Day Services

2.9.1 Day services are commissioned under individual contract arrangements with independent providers.

These services provide a range of functions that meet customers social care needs by supporting people to retain independence and promote wellbeing.

2.9.2 Commissioners are updating contract arrangements and reviewing current delivery models together with the associated cost structures.

In line with the objectives for Day Services, set out in the Lifelong Disability and Autism Market Position Statement, the Council aims to develop new

models of support which focus on progression, increased independence and community-based relationships. This approach will reduce the reliance on

building based day services, consequently no uplift is recommended for these services.

2.10 Prevention Services

The Council has recently completed a procurement exercise for Community Based Social Support services and new contracts will be awarded from April

2020 based on financial costing for 2020/21. Whilst no uplift will be applied for these, an increase of 2.5% is proposed for provision that was outside that

process.

2.11 Direct Payments

2.11.1The Council is implementing a strength-based approach to supporting individuals, this is called ‘Connecting Lives, Supporting People’. This is focussed on enabling people to remain independent for as long as

possible. The foundation of the approach is working with people to utilise their personal strengths and abilities, and the strengths demonstrated within

their networks and communities to support people in a different way. The Council will be commissioning alternative models of care and support and

consider how it can optimise the use of services and resources already in place. As a result of this changing focus people will be able to utilise their personal budget differently with more of a focus on outcomes.

2.11.2The focus on investment is to enable the development of alternative models

where they are needed by working with communities as opposed to increasing the budgets for individuals. Therefore the proposal is no

automatic increase to the rates of Direct Payment outside of the annual care reassessment process, for which a second reason is that many customers purchase services at market rates rather than the preferential prices that the

County Council is able to obtain because of its purchasing power. Instead there will be a focus on the creative use of those budgets, working with

customers to consider innovative, creative and alternative solutions that meet need within the current budget.

2.12 Resilience Fund

2.12.1The Council’s recognises that the increases makes best use of the money

available to support growth in the sector aligned to our commissioning intentions, however the Council accepts that some providers may consider that a higher uplift is required to maintain the viability of their business. A

sum of money is available as a resilience fund which provides the opportunity for providers to evidence why they should receive a higher uplift that

recommended in this paper.

Where a request is made for a higher increase this will be considered by the commissioners and operational staff as appropriate. This scrutiny will take

account of the individual, the costs and risk to which the service is exposed and the relative cost of commissioning a placement in the market. These are the key factors upon which a decision will be taken.

2.12.2Suggestions are also invited where providers have ideas that assist to build

the required capacity that supports the Council to deliver on its commissioning intentions.

2.13 Out of Scope

2.13.1Block Contracts. Any increases to rates under block contract will be determined outside of this decision in line with the obligations under the

respective contracts.

2.13.2Top Ups. Sometimes an individual or a third party may choose to pay an additional sum towards the cost of their accommodation to facilitate

additional choice of services. These payments are not the subject of this paper and will need to be discussed individually with the relevant parties.

2.13.3Deferred Payments. A deferred payment is where the Council funds a placement in a care home on behalf of an individual who has capital assets

but has insufficient cash funds, a charge to reclaim the costs is levied against the capital asset to which interest is also added. These payments are not the

subject of this paper, since they are subject to agreement between the relevant parties in the first instance with the County Council not requiring notification until this point has been reached.

2.14 COVID19

2.14.1The Council recognises that since drafting this paper the focus and priorities for providers of social care have significantly changed to adapt to the daily challenges presented by COVID19.

2.14.2The recommendations in this paper only relate to annual increases and do

not impact or influence the discrete conversations that the Council is having on how it can best support providers at this unprecedented time.

2.14.3Government grants and loans have been announced for business, additional

funding has been provided to the NHS and more recently it has been confirmed that local authorities will be given additional funding to support

sustainability of care providers at this most challenging time. Providers have made suggestion on how best the Council can support, which are being considered outside the scope of this paper.

Factors taken into account

3. Consultation

3.1 Intelligence has been gathered from requests for increases received from providers, where providers have expressed the financial pressures they are

experiencing.

3.2 Discussions have been held with board members of West Sussex Partners in

Care, the local care association, who have shared the pressures faced by providers of residential and domiciliary care. The main focus is the pressure

caused by the increases in the National Living Wage, the potential outcome of the Supreme Court’s imminent decision on the rate to be paid for sleep-in staff (Royal Mencap Society v Tomlinson-Blake) and increase in agency staff

costs, which in some cases are 3 to 4 times more than previous years. 3.3 Market oversight and reviews of providers in West Sussex are undertaken

through visits, meetings, forums and research. Intelligence is gathered and analysed, through market oversight software, that enables proactive and proportionate engagement with providers; this also supports analysis of the

volatility, sustainability and sufficiency of the care market.

4. Financial (revenue and capital) and Resource Implications

4.1 In gross terms, the County Council spends around £220m on the care costs

which are the subject of this report. £5.5m has been provided in the 2020/21 budget to fund the uplifts which are being proposed, of which £0.4m will be

met by the West Sussex Clinical Commissioning Group through the pooled budgets for learning disabilities and working age mental health. That figure consists of £3.3m as an inflation allocation plus £2.2m as a contribution

towards the cost pressure that care providers will face from the 6.25% increase in the National Living Wage from 1st April.

4.2 Quantifying the impact of the recommendations is not a precise science,

because the group of people receiving social care is subject to a significant level of turnover each year. Of itself this will lead to changes in the relative

mix of spending and so the cost of any individual element of the package of proposals cannot be stated with complete certainty. Thus affordability has to be assessed in a reasonableness sense by applying the proposals in section 2

to current customer numbers. On that measure the forecast cost of the recommendations accounts in full for the resources that are available. This

includes the resilience fund, which is being created from a reprioritisation of the overall cash envelope.

Year 1

2020/21 £m

Year 2

2021/22

£m

Year 3

2022/23

£m

Revenue budget

5.5 5.5 5.5

Cost of Proposal

-5.5 -5.5 -5.5

Remaining budget

0 0 0

5. Legal Implications

5.1 There is a low risk of legal challenge by providers if they feel that the County Council has not met its duties under the Care Act and are not paying

sufficient fees to enable them to be sustainable. The proposals therefore prioritise markets where supply is constrained and where the County Council is seeking to expand capacity.

6. Risk Implications and Mitigations

6.1 There is a potential risk of legal challenge by providers if they feel that the

County Council has not met its duties under the Care Act and is not paying sufficient fees to enable them to be sustainable.

6.2 The County Council is experiencing increasing difficulties in securing placements at its indicative rates. This is a reflection of market pressures,

where a combination of loss of capacity and growing demand is exerting an upwards influence on prices. The proposals in this report attempt to acknowledge that position by providing increases that take into account both

the effect of the National Living Wage and inflation, but also by investing in alternative services to residential care. As a result, the County Council is

likely to be in a better position to secure services at the indicative rates, which minimises the need to purchase services at a higher rate (see 1.3). The Council also has a number of block arrangements in place that will help

to mitigate cost increases.

6.3 As fees paid in respect of care provision is a national, high profile issue, there is a potential reputational risk, if the County Council is not seen to be setting

fees at reasonable rates. The proposals above, within the available budget, attempt to mitigate this risk, also they are not dissimilar to proposals and rates paid by neighbouring authorities. Moreover, by introducing a resilience

fund, the County Council will be in a position to give specific consideration to applications from providers who can evidence that the proposals may

jeopardise the on-going viability of their business. It is also intended to signal that change is needed in the way that care is delivered and so the fund is equally available to support providers to adapt to the County Council’s

future requirements.

6.4 In order to ensure the uplifts to fees are paid there is a reliance on a number of teams across Adults Services, Lifelong Services, Business Systems Support and the Capita partnership. Mosaic is the system within which rates

are captured and from which purchases for individual are made; it is critical that the updates are made in a timely manner to ensure on time payment to

providers and notifications to customers. Every effort will be made to ensure that the increases are paid as near as possible to 6th April for Indicative Rates, or other dates as stated in providers’ contracts. There is a risk that

some new rates may be paid retrospectively, if this happens arrangements for backdating will be communicated to providers.

7. Other Options Considered (and reasons for not proposing)

7.1 A number of options for fee increases have been considered including increases based on Retail Price Index, Consumer Price Index, modelling different rises on different breakdowns of estimated staff costs and other

costs and to a uniform uplift across all service provision.

7.2 The reason why the alternative proposals were not taken forward is that

some segments of the market are showing mores signs of fragility that the alternative approaches would not have addressed. The approach adopted takes account of the Council’s vision for adults, known commissioning issues,

related market issues and positions the funding to incentivise innovation, investment or encourage growth in the required service areas, something the

other approaches did not take into account.

8. Equality and Human Rights Assessment

8.1 All care groups were considered in determining the approach for fees and rates to encourage a fair and uniform approach. The proposals will not have a

disproportionate effect, either negative or positive, on any person with a protected characteristic in comparison to those without those characteristics.

8.2 Whilst the fee uplifts proposed are applicable to customers who meet the national eligibility threshold and are eligible for financial support from adult social care to meet their assessed needs, they take into consideration our

wider Care Act responsibilities in relation to market shaping and encourage a viable market of diverse, sustainable services delivering quality care all

customers regardless of how they are funded. For those customers who are full cost payers and those choosing to respite from a personal budget there will be an effect on the sum they are recharged. There may also be a negative

impact on residents generally if providers choose to increase their own rates.

8.3 Any negative impacts, though, must be balanced against the duty the County

Council has under the Care Act to ensure the sustainability of the care market and to ensure that there is diversity and quality of provision in the market.

8.4 The proposals outlined in this paper are intended to support providers to continue to deliver quality services (and improve, where required) to meet all customers’ individual needs, circumstances, cultures and lifestyles, hence

ensuring that where customers personal circumstances and support needs change, that there is sufficient provision in the independent sector available

to support them.

8.5 In reaching a decision on the level of fees, the Council has considered its duties under the Human Rights Act, and in particular Article 8, and the need

to consider the private and home life interests of all those assessed to be in need of residential and other basic care. The Council has endeavoured to

ensure that the proposals in this report enable these needs to be met.

9. Social Value and Sustainability Assessment

9.1 The proposals support the sustainability of the care market in West Sussex

by paying an increase to those providers evidencing greater signs of fragility and also signals to the market how the market needs to shape to meet future demand in a way that is sustainable people requiring support, the public

sector and to them as part of the care market.

9.2 The annual increases to nursing and dementia provision, under indicative rates, may encourage more providers to support County Council funded

customers and also encourage new investors into West Sussex.

10. Crime and Disorder Reduction Assessment

10.1 There are no Crime and Disorder Act implications.

Kim Curry

Executive Director of Adults and Health

Catherine Galvin

Head of Commissioning

Contact Officer: Debbie Young, Commissioning Lead-Quality & Supplier

Management. Tel 0330 2224134.

Appendices

Appendix 1: Adults’ Social Care Areas for Enhanced and Standard Rates

Appendix 2: Fee Schedule Proposed Fee Rates for 2020-21

Background papers

None

Appendix 1 Indicative Rates Schedule 2020-21

CARE HOME RATES

ADULTS' SERVICES INDICATIVE RATES FOR PERSONAL AND NURSING CARE IN

REGISTERED CARE HOMES (ALL AGE GROUPS)

CARE HOMES REGISTERED WITH THE

CARE QUALITY COMMISSION TO

PROVIDE PERSONAL CARE

2019-20 from

8/04/19

Weekly Rate

£

2020-21 from

6/04/2020

Weekly Rate

£

Band B – High level of physical care needs DISCONTINUED

£ (in pay) 423.32

DISCONTINUED

£ (in pay) 423.32

Band C - Specialist dementia care

(intensive/complex)

Standard 591.75 Standard 615.42

Enhanced 686.65 Enhanced 700.38

Band P - Frail with intensive/complex

physical care needs

Standard 528.27 Standard 528.27

Enhanced 655.39 Enhanced 655.39

Band F - Person with mental health needs DISCONTINUED

(in pay) £407.74

DISCONTINUED

(in pay) £407.74

CARE HOMES REGISTERED WITH THE CARE QUALITY COMMISSION TO PROVIDE

NURSING CARE

Baseline Social Care Rate (Accommodation

and Personal Care element of Nursing Fee)

Standard

563.63 Standard

586.18

Enhanced 631.95 Enhanced 644.59

NHS CONTRIBUTION TO NURSING CARE – FUNDED NURSING CARE (FNC)

CARE HOMES WITH NURSING

2019/20 from

1/4/19

Weekly Rate

£

2020/21 from

1/4/2020

Weekly Rate

£

Standard FNC

£165.56 tbc

High FNC £227.77 Tbc

RESPITE STAY INCENTIVE PAYMENT – NEW FROM 6/4/2020

For stays up to 14 nights at indicative rates, an additional pro rata

payment.

Standard 21.00

Enhanced

NOTES

i.WSCC pay fees net of FNC, with reimbursement for all FNC being paid directly from the CCG. This

is addition to the baseline social care element.

ii.Prices stated are gross.

iii.Substance Misuse, Learning Disability, Mental Health, Physical Disability and where need exceeds

indicative rates are agreed on an individual basis.

iv.Enhanced rates are paid for homes within the Adults’ Services Northern area and Northern

Chichester (i.e. those homes listed in the West Sussex Care Guide under Midhurst, Pulborough and

Billingshurst)

Appendix 2 Northern Area and highlighted towns in Western = Enhanced Rates

Southern & Western Areas (exc. highlighted towns) = Standard Rates